SAN FRANCISCO GENERAL: Launches New ER Program For Chronic Users

      San Francisco General Hospital is responding to the problem of "frequent users" of its emergency room with "an unusual program that may be the first of its kind in the country," the San Francisco Examiner reports. "[F]requent fliers" show up in the emergency room anywhere "from five to 50 times a year with anything from a cold, chronic pain, skin ulcers and stab wounds to AIDS-related illness." Christine Wachsmuth, San Francisco General's associate administrator for emergency and trauma services, said, "We're not a food bank, a clothing bank, a social services department, but that is what we're being asked to do."

Pilot Program
      In 1995, San Francisco General launched a pilot project with a grant from the city Public Health Department called the "Case Management Program" to lessen emergency room use. The program was the brainstorm of Dr. Robert Okin, who "notice[d] many of the same faces day in and day out" in the hospital's emergency room and "began to wonder what they were doing there." Dr. Okin and colleague Dr. Alicia Bocceliari reviewed the charts of 200 frequent users and found that "the majority ... were homeless, had major substance abuse problems and had suffered severe emotional and physical trauma in their lives in addition to significant medical problems." Okin said, "I have a very different notion of what a hospital ought to be doing. I have a notion that unless we can attend to the (psychological and social) part of people's lives, it's going to be hard to stabilize their medical problems."

It's A Plan
      Under the program, "[t]hose who used the emergency room more than five time were referred to social workers," where they became "clients" rather than "patients." While "[t]here was a drop-in office at the hospital," most of the work was done outside of the hospital and "[a]ttempts were made to find housing, welfare benefits, counseling, regular medical care." The Examiner reports that the "[p]reliminary results were dramatic," with a "pilot study of 16 frequent users" finding a 45% drop in emergency room use and a 38% decrease in hospital admissions. In addition, it is estimated that the program has "saved taxpayers more than $250,000." Today the program "includes eight case workers" and more than 200 enrollees, many of whom "will be followed but not counseled" as part of the study. Okin said, "I think if we're able to demonstrate results in the controlled study, this will have a significant impact on how other large urban hospitals view and care for these patients" (Seligman, 2/22).